Consent, the responsibility we have to seek it in all our interactions.

This weekend we went to see TEDxCardiff and it was fantastic. Hundreds of people packed into a room on a Saturday to be inspired, amazed and provoked into thinking more deeply.

I love TED talks. I love watching someone share their passion, knowledge and excitement for a topic. They challenge the current thinking, plant the seed, celebrate and amaze. When I’m feeling stuck I put on a TED for inspiration and am never disappointed.
There were so many great talks I won’t go into them here, but suggest you check out www.tedxcardiff.co.uk if you want to see more. Two talks stood out for me:

The first was Dilys Price OBE – a skydiving soon-to-be-85-year-old who utterly lives every day. Taken from her TEDxCardiff bio:

“Her ethos is:
1. if you fall off your bike, get back on & do wheelies
2. find the jewel in the sh*t
3. get a passion
4. be kind to as many as you can, as often as you can, to whomever you can ,where ever you can, in any way you can.”
Watch her incredible videos here: http://www.skydiverdilys.co.uk/about-us.html#videoclips

The second was an exploration of the line between science and art by a playwright, how they inhabit different languages and how they should and can be brought together for the betterment of the national discussion of big topics. Great. After speaking for a while she brought out an actress to give us a small section of her recent play exploring organ donation. What followed was 6 or 7 minutes of an excruciatingly heart-breaking monologue where she was in a traffic accident with her child, on ICU and eventually her heart was taken for donation. We lived every moment of it with her, her pain and suffering, her turmoil, her confusion. It was a great performance and utterly horrifying.
Sitting in my seat I utterly burned with anger at the playwright and the actress and it took me a few moments of reflection to understand why.

I hadn’t given my consent for that.

I hadn’t consented to being made to feel that way. I had come to TEDx to be challenged in my thinking and perceptions, and yes, potentially moved. But in a way that I expected from watching previous TEDx talks. Yes, I’ve watched heart-breaking stories that have really touched me, but my consent to those emotions was implicit in choosing to watch the talk I’d read the outline for. I’m a regular theatre-goer and enjoy being challenged by difficult and complex topics well debated on stage, but my expectation for potentially difficult emotions is set when I choose to book tickets.

Choosing.

That’s an important point and one that made me consider how our patients feel when they attend their appointments. How do we gain their consent to discuss difficult topics to do with their nether regions? It’s well documented that we as healthcare practitioners get used to terminology and pathology and don’t remember how it first felt to hear people using taboo language. We live in an environment of pathways and processes and illness and suffering as the norm, where simple incontinence could be so miniscule on the scale of pathologies we grapple with daily that we can be guilty of dismissing what can be devastating for some.

I can imagine that being accosted by someone you met 15 minutes ago asking how your vagina feels during sex or whether you leak urine during exercise could be as troubling for someone as I felt during that TEDx talk. Did you consent to that?

I think the key here is to set up expectations. I do that by ensuring all my patients fill out an Australian Pelvic Floor Questionnaire/Queensland in the waiting room – it may not be the most appropriate for them and their symptoms but it asks questions about the bladder, bowel, sex and prolapse symptoms before they meet me. This sets up the expectation that I will be asking about all of these areas and it gives them a cue to the language they can use to discuss their symptoms. I’m also very respectful of any areas they’ve not filled out – always asking whether this is an area they’d prefer not to discuss rather than assuming they didn’t see to turn over the paper, then launching myself into an area of questioning that may open up a Pandora’s box of hurt for them.

Remember that Consent is a continuous process. You gain consent for each question, each area, each part of their story they’re willing to share with you. Set expectations for what is appropriate and be respectful of their boundaries (and yours!) and you’re more likely to get a complete picture.